Long-term outcomes after 1000 heart transplantations in six different eras of innovation in a single center

• Published in: Transplant international Vol. 22; no. 12; p. 1140
• Main Authors: Kofler, Sieglinde, Bigdeli, Amir K, Kaczmarek, Ingo, Kellerer, Diana, Müller, Thomas, Schmoeckel, Michael, Steinbeck, Gerhard, Uberfuhr, Peter, Reichart, Bruno, Meiser, Bruno
• Format: Journal Article
• Language: English
• Published: England 01-12-2009
• Subjects: Adolescent; Adult; Aged; Female; Graft Rejection; Graft Survival; Heart Transplantation - methods; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Nitric Oxide - metabolism; Organ Preservation Solutions; Retrospective Studies; Tacrolimus - therapeutic use; Treatment Outcome
• ISSN: 1432-2277
• DOI: 10.1111/j.1432-2277.2009.00931.x

The objective of this study was to evaluate long-term outcomes of cardiac transplantation (HTx) in different eras of innovation at a single center during a period of 27 years. We performed a retrospective analysis of 960 cardiac allograft recipients (40 re-HTx) between 1981 and 2008. The results of six different eras based on milestones in HTx were analysed: Era 1: the early years (n = 222,1981-1992); era 2: introduction of inhalative nitric oxide, prostanoids, University of Wisconsin solution (UW) replacing Bretschneider's solution (HTK,n = 118, 1992-1994); era 3: statins (n = 102, 1994-1995); era 4: tacrolimus(n = 115, 1995-1996); era 5: mycophenolate mofetil (MMF, n = 143, 1997-2000) and era 6: sirolimus (n = 300, 2000-2008). Outcome variables weresurvival, freedom from cardiac allograft vasculopathy (CAV) and from acute rejection episodes (AREs). Differences in survival was found comparing era 1 and era 2 with era 4 and era 6 (P < 0.001). Organ preservation through UW demonstrated a significantly better survival as compared with HTK(P < 0.001). Less AREs occurred in patients receiving tacrolimus-sirolimus ortacrolimus-MMF (P < 0.001). Patients receiving tacrolimus-MMF showed less CAV than when treated with cyclosporine-MMF (P < 0.005). There were more ventricular assist device implantations and more re-HTx in era 6 (P < 0.0001)than when compared with other eras. Although the causes for improvement in survival over time are multifactorial, we believe that changes in immunosuppressive therapy have had a major impact on survival.